In contrast to “The Biggest Loser,” which features contestants competing against each other for money, “Extreme Weight Loss” features one to two people on each episode. And, as illustrated by the July 8 episode, their battle to lose weight often involves shedding the burdens of the past as well as their obesity.

Weighing more than 400 pounds, David was a man haunted by his past. At age 17, he was taking care of his siblings when one of his little brothers accidentally shot the other. In addition to that death, David felt responsible for the subsequent death of his little sister when she experienced a seizure and died in her sleep after he did not give her medication one night.

But when he finally sought the courage to ask “Extreme Weight Loss” transformation specialist Chris Powell for help, David’s life changed in every way. During his 365 days with Chris, David learned to let go of his guilt while taking up the new weapons in his weight loss war of diet and fitness.

Highlights included David’s chance to become a mixed martial arts (MMA) fighter and, just before weighing in at the finale to discover he lost half of his body weight, his proposal to the girl he loved. But his battle become free of his guilt was not easy, pointed out Dr. Holly Wyatt, Medical Director at AHWC and Medical Director for the show, in a July 9 interview with ABC News.

“I think it was appropriate that it aired after the Fourth of July weekend because it’s all about freedom. Not the freedom we celebrate as a society, but the freedom we celebrate as individuals to enjoy our own lives,” said Dr. Wyatt.

For those who are obese, Dr. Wyatt emphasizes that it takes mental and emotional work to transform. Until David “could deal with that and learn to feel he deserved a change, he could not dig deep and do the hard work needed to transform his life,”she commented. “He had to shed his emotional burden, along with his weight, to achieve his transformation.”

Along the way, it was clear that David had to learn to reach out and ask for help. And his support came from unexpected sources, such as the Ultimate Fighting Championship (UFC) contenders who graciously offered him the opportunity to demonstrate what he had learned in the gym as he built muscle and lost fat.

Yet the episode was also a reminder of just how life-threatening it can be to struggle with obesity. As David worked out, he began vomiting and suffering from chest pains. He had suffered a heart attack, reported ET News on July 8.

“When you start to look at the dizziness, the nausea, the vomiting and especially the heart palpitations, that was the final straw,” explained trainer Chris Powell of his decision to call it quits temporarily and rush David to the hospital. But now that David has lost his excess weight and gotten fit, Powell predicted: “I can promise you he’s not going to have a heart attack any time in the near future.”

In recent years, a controversy about precisely what constitutes a heart-healthy diet has become heated. Despite increasing evidence that consuming saturated fats is not the cause of heart disease, some experts still recommend limiting red meat, revealed the Cleveland Clinic’s Health Hub News on July 9.

Stanley Hazen, MD, Head of the Section for Preventive Cardiology and Rehabilitation at the Cleveland Clinic, argues that the newest studies are akin to “mathematical massaging of multiple databases.” As a result, he still recommends the traditional diet plus exercise prescription.

“The Mediterranean diet showed through randomized intervention trial to reduce cardiovascular disease events an additional 30 percent on top of other therapies like medications and exercise. That is still my recommendation,” stated Dr. Hazen.

However, the type of diet that Chris and Heidi Powell use is called carb cycling. It involves periods of low carb diet menus followed by high carb plans. The duo say that it boosts weight loss and helps the metabolism function at optimal level.